8 Self-Care Techniques for an Impending Mixed Features Episode

OK, it’s transparency time. Transparency is essential to fighting stigma and helping those who may not live with a mental health diagnosis (or diagnoses) understand a little bit of what we face daily. The truth is, sometimes living with Bipolar Affective Disorder is absolutely no fun. This has been the case for me these past two weeks. See, I’m trying to get in a groove with the scheduling for posts on this blog. I’m on track to do that for next week, at least. I have caught an expanded vision for this blog that really excites me, and I’m so looking forward to putting it into action! But, I missed the mark this past week and the week before, and the depression that caused me to miss that mark also tells me what a failure I am and that I will never be able to make this space line up with my vision. Then, the more manic symptoms tell me that I don’t have to. Whatever I do, everyone will love it, and everything I touch will turn to gold because I’m freaking unstoppable. (One symptom of mania is grandiosity, and in me, it tends to take the form of making ridiculous plans and just assuming that everything will come together because, hey, how could it not with how amazing I am.) I’ll be honest, even typing that makes me feel like an arrogant jerk. I hope you’ll forgive me.

I assume if you’re reading this, you’re at least a little familiar with the basics of depression and a Manic episode (links provided in case you’re not). I’d like to briefly describe my experiences with each before getting into the meat of this post. Depression is an aching in my bones. It’s the searing knowledge that nothing has ever been right and nothing will ever be right, but the simultaneous numbing of all pain receptors. It’s feeling my whole body slowly petrify. It’s being unable to get out of bed some days and also being unable to even muster the energy to care. It’s running my fingers through my hair in exhaustion and realizing only then that I’m a greasy mess who hasn’t showered in days. Then, there’s (hypo)mania. When everything is perfect and I am amazing and I can do no wrong. It’s unrestrained energy and excitement. Now, that might sound fun, and it is – at first. I’m charismatic and I can probably get you just as excited as I am about [insert Amazing, World Changing, New Idea here]. But then, things get pretty overwhelming. The best analogy I can come up with is when you go on one of those super-fast, spinny rides at the fair. At first, it’s thrilling; then it starts to make you sick and you wonder when it’s going to stop. It’s being so energized you can’t sit still. It’s having so many ideas flying through your brain that you can’t grab just one. It’s jumping between ten tabs on your browser, all on different topics, and only being able to stick with any one long enough to read a sentence or two, but trying to make sense of what you’re reading anyway. Trying to blend the sentence fragments into a coherent reading experience, then getting frustrated that you can’t make it make sense.

Then, there is the dreaded Mixed State. And it truly is a beast. It’s hard to explain, really, even for me. The technical definition is that you have symptoms of Mania and Depression at the same time or in rapid succession. Try to imagine that for a minute. It’s being depressed but energized. It’s having fantastic ideas of things I want to accomplish all while depression screams in my face that I can never accomplish anything. It’s being hyper and hopeless at the same time. It’s wanting to do nothing but sleep all day, but being unable to sleep at all. It’s pacing the kitchen at 4 AM, crawling in my skin, with quick snapshots of everything I’ve ever done wrong in my life flickering before my eyes, and being simultaneously unable to break the train of thought and unable to focus on just one event or memory. It’s sensory overload on every level. It’s just a big collection of suck.


Well, here we go! (Resigned to the coming battle)

Were it not for my meds, I have no doubt I would have been in a full-blown Manic with Mixed Features episode these past two weeks. Meds, thankfully, muted the effects a bit. But the basic symptoms were still present, if less severe than they have been in the past.

All of that to say, today is supposed to be a post about self-care. What steps can we take to practice self-care while in the midst of a Mixed Episode? That’s the question of the week!

The first, most important part of self-care with BPAD is pre-episode, daily management. Being aware of subtle changes in your mood, following a schedule, taking a PRN sleep aid the first night you can’t sleep, within the first two hours of trying to sleep and realizing you can’t. Eating well, even when you’re not hungry. Reaching out and connecting with people, even when you don’t feel like it. Taking all of your meds as scheduled. And so on. This is the “do as I say, not as I do” part of the post, I admit. I’m still working on getting a handle on the whole “schedule” thing, I hate my PRN sleep pill because it makes me groggy all of the next day, and I’m not even going to touch the eating thing. That said, I recognize that these things are important and I am working on it!

Alright, you say, preemptive management is good, but what do you do when you’re already barreling toward a Mixed State or in one that hasn’t reached red alert crisis levels yet? Agitated depression, paranoia, no sleep, racing thoughts are here or right around the corner… what can you do?

  • Stick with your meds even though you probably have no interest in taking them. I set alarms in my phone and I know, no matter what, I have to take them when the alarm goes off. This can help minimize the impact of your symptoms on your overall day to day life and prevent the need for a hospitalization or a full-blown crisis situation.
  • Reach out to a friend/family member/treatment team person. Maybe this feels absolutely impossible. But if you’re aware that your mood is spiraling, asking someone you trust to check in every day can be the difference between a rough few weeks and a very dangerous situation. I have a really good friend who calls me four to five times a week and helps me keep track of things. Remember other people have their own lives, though, and you can’t count on them for everything because they have their own stuff going on. But even a 10 minute phone call every other day can go a long way. IMG_20170429_030324_285.jpg

Yes, I’m using a picture from Disney Land. The sword is a metaphor, though. Sometimes we need help. Friends are great at helping. Let your friends help. ❤ 

  • Keep crisis lines saved in your phone. Really. If it’s 4 AM and you’re feeling unable to handle the chaos in your brain, having a support you can call no matter the time of day can be immensely helpful, if not life saving. Keep them in your contacts and use them.
  • Make sure your friends and family know what to look out for. This article may be helpful to share with your family/ friend support system. The fact is, once the episode becomes full blown (whether traditional mania or one with mixed features), we don’t really have the ability to realize what’s going on or what we’re doing or feeling. If you live with BPAD, you know that. That’s where an extra set of eyes (or two, or ten) can really come in handy. Someone outside of you who can help keep tabs and manage things is essential.
  • Avoid alcohol and mind-altering drugs. This is essential. I understand the temptation, that need to do something, anything, to stop feeling what you’re feeling. But it’s just going to make things worse and less manageable for you in the long run. If this is a big struggle for you, take care to avoid triggers during this time. Don’t hang out with friends you drink with. If it’s a REALLY big struggle, have a friend or family member go to the store with you if you need to go so that you don’t convince yourself that buying that bottle of wine on the shelf won’t hurt. Really, it will. I promise. Drinking is going to make things much worse for you. IMG_20170429_040108_636000.png
  • What’s in your Kit Bag? “Kit Bag” is a term I learned from a friend to refer to a sort of “emergency self-care kit”. If you don’t have one, I highly recommend making one now. It doesn’t have to be an actual bag of tangible things. It can just be a list. When you’re recognizing mixed features but they are not yet full blown, it’s time for self-care central. What people, places, and things make you feel most at peace and in control? Hot showers? Mindful cooking? A favorite movie? Calling a friend? Seeing your therapist? Come up with your list and use it! Some people also do have a tangible bag with things like a DVD of said favorite movie, a bottle of favorite bubble-bath, some beloved recipes, notes of encouragement and love from family and friends, etc. Find what works for you and do it.
  • Challenge you’re thinking. If you’ve ever done Cognitive Behavior Therapy, you know that negative self talk and distorted thinking can overtake us at any time. You also know that there are ways to challenge these thoughts. My favorite method is the one that feels the least threatening – I think of one fact that suggests that my negative thoughts are not 100% true, 100% of the time. I say “least threatening” because, as backward as it may sound, my negative self-talk and distorted thoughts are pretty thoroughly ingrained in my mind, and I’m so used to them that the idea of getting rid of them is sometimes more scary than the thought of continuing to live with them. So challenging them outright is always difficult and sometimes impossible. But, I’m also a very analytical person, so finding one fact, one event, one moment in time, that demonstrates that my negative thoughts are not 100% true feels pretty manageable to me. By doing this, over time, you do start to fight against the entire thought. But it’s all about baby steps.
  • Finally, if you are truly in crisis, get to a hospital. Have a safety plan in place with your supports. Set limits. If you cross the line on those limits, it’s time to go get the next level of help. Look, no one likes hospitals. Especially not psych units. I know. I get it. But I also promise you your future self will thank you for going.


Literally me checking into the psych unit. Taking a selfie was maybe not rational, but, honestly, I was pretty thoroughly irrational at the time. Really, though, it’s OK to need help, and sometimes we do need that “higher level” of support. There’s no shame in that! 

So, that’s my little list. The fact of the matter is self-care while heading for a mood episode of any form is a tricky proposition, and preemptive planning with your support team is the best way to manage it. But if you, like me, are living with some of the symptoms, but they are muted enough to not require hospitalization, self-care can really help you ride it out. It’s going to suck, there’s no getting around that, but having good self-care techniques and good supports can be the difference between a crappy couple of weeks and a crisis requiring hospitalization. It does require a certain awareness of mood and an understanding of what is happening, though. Which is where the friends and family come in. In the week heading into this episode, on three of my phone calls with my friend, she noticed that I sounded “in a fog”. This was a big cue to me that things were not well and that I was heading for a bad time. So, self-care kicked into overdrive.

Self -care is going to look different for everyone, of course. And I feel obligated to mention that Mixed States are often the most dangerous types of mood episodes, because being depressed but energized tends to facilitate making and carrying out a suicide plan. So, please take care of yourselves. And, not to beat a dead horse, but IT’S OK TO NEED HELP at whatever level is necessary.

If you’d like some specific techniques for getting through a particularly difficult time, check out my list: Top 5 Ways to Get Through a Bad Situation (Without Making It Worse).

What are your go-to emergency self-care techniques? Do you agree with this list? Disagree? I’d love to hear your thoughts in the comment section of this post! You can also Tweet me and find me on Facebook. Thanks for reading!


3 thoughts on “8 Self-Care Techniques for an Impending Mixed Features Episode

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